What is Eczema?
Eczema (atopic dermatitis) is a chronic inflammatory skin condition characterised by intensely itchy, dry, inflamed skin that typically follows a relapsing-remitting course. It affects approximately 20% of children and 3% of adults worldwide. Eczema is part of the "atopic triad" — many patients also have asthma and allergic rhinitis. The condition results from a combination of genetic skin barrier defects and immune dysregulation.
Types of Eczema
| Type | Features | Common Sites |
|---|---|---|
| Atopic Dermatitis | Most common; linked to allergy, family history, asthma | Flexures (elbow, knee creases), face in children |
| Contact Dermatitis | Triggered by specific allergen (nickel, latex, cosmetics) or irritant (soap, detergent) | Wherever contact occurs |
| Seborrhoeic Dermatitis | Yeast-related; scalp, face, chest — not truly "atopic" | Scalp (dandruff), T-zone, chest |
| Discoid (Nummular) Eczema | Coin-shaped patches; often in adults; can be very itchy | Limbs, trunk |
Blood Tests in Eczema
| Test | Finding in Eczema | Purpose |
|---|---|---|
| Total IgE | Elevated in ~80% of atopic eczema patients | Confirms atopic status; very high levels suggest significant allergic sensitisation |
| Specific IgE (RAST / ImmunoCAP) | Identifies specific allergens causing sensitisation | Tests for house dust mite, pet dander, food allergens (milk, egg, peanut in children) |
| CBC — Eosinophils | Elevated eosinophils (eosinophilia) common in atopic conditions | Marker of atopic and parasitic activity |
| Skin swab for culture | Staphylococcus aureus colonises eczema skin in majority of patients | Identifies secondary bacterial infection requiring antibiotic treatment |
Common Triggers
| Trigger Category | Examples | How to Manage |
|---|---|---|
| Environmental allergens | House dust mites, pollen, pet dander, mould | Dust mite covers, regular vacuuming, HEPA filters |
| Food triggers (mainly children) | Eggs, cow's milk, peanuts, wheat, soy | Identify through dietary diary and supervised elimination; avoid confirmed triggers |
| Psychological stress | Exams, life stressors | Stress management, mindfulness; flares predictably follow stressful periods |
| Heat and sweating | Exercise, hot weather | Cool showers after exercise, lightweight breathable clothing |
| Soaps, detergents, fragrances | Bubble baths, scented products | Use fragrance-free, soap-free cleansers and emollients |
Treatment Ladder
Step 1: Moisturisers (Emollients) — Used Continuously
The cornerstone of eczema management. Apply generously multiple times daily to ALL skin, not just affected areas. Use immediately after bathing (pat dry, don't rub). Examples: liquid paraffin-based creams, Cetaphil, Dove, or prescribed emollients. Using 250–500g per week is not unusual for significant eczema.
Step 2: Topical Corticosteroids for Flares
Apply to active eczema patches only during flares. Use the lowest potency that controls the flare. Mild steroid (hydrocortisone 1%) for face; moderate (betamethasone valerate 0.025%) for body; potent (betamethasone dipropionate 0.05%) for thick lichenified skin. Use for short bursts (7–14 days), then stop. Fingertip unit dosing guides correct application.
Step 3: Topical Calcineurin Inhibitors
Tacrolimus (Protopic) and pimecrolimus (Elidel) are steroid-free anti-inflammatory creams. Particularly useful on the face and eyelids where steroids cause side effects. Good for long-term maintenance on sensitive areas.
Step 4: Dupilumab (Biologic) for Severe Eczema
Dupilumab (Dupixent) is a biologic injection targeting IL-4 and IL-13 — the key inflammatory cytokines in eczema. It is highly effective for moderate-to-severe atopic dermatitis not controlled by topical treatments. Given as subcutaneous injection every 2 weeks. Approved for adults and children ≥6 years.
Questions to Ask Your Doctor
- Should I have allergy testing (IgE panel) to identify my triggers?
- Which strength of topical steroid should I use and for how long?
- Is there evidence of secondary bacterial infection in my skin?
- Am I using enough moisturiser?
- If my eczema is severe and not responding, could I be referred for dupilumab?